Provider Demographics
NPI:1487199253
Name:PEARSON, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 SE SALMON ST
Mailing Address - Street 2:SUITE L5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3375
Mailing Address - Country:US
Mailing Address - Phone:503-754-8905
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST
Practice Address - Street 2:SUITE L5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3375
Practice Address - Country:US
Practice Address - Phone:503-754-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health